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BREASTFEEDING - FREQUENTLY ASKED QUESTIONS

Healthy babies under two years old often get oral thrush. It's most common in babies around four weeks' old.

If your baby has oral thrush and you're breastfeeding, it's possible for your baby to pass a thrush infection to you. The infection can affect your nipples or breasts. It's commonly called nipple thrush (mammary candidosis or mammary candidiasis).

What are the symptoms of nipple thrush?

The symptoms of nipple thrush may include:

• pain while you're feeding your baby, which may continue after the feed is finished - this can start to happen after feeding has been going smoothly,
• cracked, flaky or sensitive nipples and areola (the darker area around your nipple),
• areola that is red or shiny, or
• a shooting pain, burning or itching sensations in one or both of your breasts, which may continue between feeds.

It's also possible that you may have no symptoms of infection.

Symptoms of nipple thrush do not include fever or redness of your breasts. However, these can be symptoms of mastitis (inflammation of the breast)

It's more likely that your baby can pass a thrush infection to you if you have had:

• cracked nipples before because your baby was not positioned correctly when feeding, or
• other thrush infections.

It may also be more likely if you've been taking antibiotics. This can reduce your level of healthy bacteria, allowing the fungus that causes thrush to increase.

What else could it be?

A nipple thrush infection is difficult to diagnose, because:

• you may have no symptoms, even if it's confirmed that your baby has oral thrush, and
• any symptoms you do have may also be found in other conditions.

For example, pain in your nipples could also be caused by a bacterial infection.

However, if your nipples are sore, painful or cracked, the most likely cause is that your baby is not attached to your breast correctly when it's feeding.

Positioning your baby correctly

There are several ways you can check that your baby is positioned correctly on your breast. For example, it's important that your baby open its mouth wide when it's 'latching on' to your breast.

If you have sore nipples or pain in them, learning how to reposition your baby may solve the problem. For more information, see breastfeeding in 'further information' below.

If the pain in your nipples continues once your baby is positioned correctly, you should seek further advice from your midwife, health visitor or GP.

Will I need treatment?

If you have no symptoms, you're unlikely to need treatment, even if it's confirmed that your baby has oral thrush.

If you do have symptoms, or if the infection is causing problems with feeding, your GP may prescribe an antifungal cream, such as miconazole. You should apply the cream to your nipples after every feed, and remove any that's left before you feed your baby again.

If your infection is more severe, your GP may recommend a course of antifungal tablets, such as nystatin. For example, if the infection has gone deeper into your breasts and spread to your milk ducts.

If your GP prescribes antifungal cream or tablets for you, your baby will probably be treated at the same time, to prevent re-infection.

If the infection does not clear up after a few days, or if feeding problems continue, you should visit your GP again.

Getting help

If you think you have nipple thrush or mastitis, you should seek advice from your midwife, health visitor or GP.

A breastfeeding counsellor may be able to provide specialist advice about feeding problems. You can also ask your midwife, health visitor or GP for advice about feeding your baby. Or you can call NHS Direct on 0845 4647.

Can I take cough and cold remedies while I'm breastfeeding?

If you have any concerns about the information below, or need any help understanding it and relating it to your own situation, you should talk to your GP or pharmacist (chemist). You can also phone NHS Direct on 0845 4647.

This information only applies to full term, healthy babies. Further advice should be sought if your breastfed baby is premature, low birth weight or has an underlying medical condition.

The majority of coughs and colds will get better on their own, and medicines may not help. Symptoms can often be relieved with simple measures such as rest, plenty of fluids, paracetamol and inhaling steam. These measures should be the preferred choices if you are breastfeeding.

Products sold for the treatment of coughs and colds usually contain several ingredients, each intended to ease a different symptom. It is recommended that individual drugs are used for specific symptoms; some people however like to take 'all in one' preparations.

Most combined medicines for coughs and colds contain two or more of the following:

Diphenhydramine, triprolidine and promethazineare the antihistamines most commonly found in cough and cold remedies. All three drugs cause drowsiness, and are generally not recommended if you are breastfeeding as they may cause effects such as irritability, drowsiness or stop babies sleeping properly.

Decongestants

Pseudoephedrine, phenylephrine and phenylpropanolamine are the decongestants most commonly found in cough and cold remedies. If you are breastfeeding the use of phenylephrine and phenylpropanolamine is not recommended. However, limited information indicates that the amount of pseudoephedrine passing into breast milk is small and breastfeeding after occasional doses is considered safe.

Cough Suppressants

Dextromethorphan is a cough suppressant commonly found in cough and cold remedies. It may be considered for occasional use if you have an unproductive and severe cough. However drinking plenty of fluids and inhalation treatment are considered treatments of choice.

Pholcodine linctus is another cough suppressant. There is no research on the effects of pholcodine on breast fed babies so is not recommended in breastfeeding mothers. Again, plenty of fluids and inhalation treatment are the best treatments of choice.

Cough Expectorants

It is recommended that you should avoid guaifenesin if you are breast feeding.

Simple linctus contains citric acid, which is also widely found in foods and beverages as flavouring. It is is considered safe to be taken by breastfeeding mothers.Glycerin and honey linctus is considered safe to be taken by breastfeeding mothers.

Vitamin C (ascorbic acid) is included in a number of combination cough and cold remedies. The inclusion of vitamin C in cough and cold remedies is considered safe to be taken by breastfeeding mothers.

Is it safe to breastfeed if I have diarrhoea and vomiting?

There are very few illnesses in mothers that mean you should stop breastfeeding. Most common illnesses, like colds and flu, can't be passed through breast milk. In fact, if you are unwell your breast milk will contain antibodies (disease-fighting substances), which help to protect your baby from getting the same illness.

If you have vomiting and diarrhoea you should carry on breastfeeding, but make sure you drink plenty of liquids to keep up your fluid levels and prevent dehydration. See your GP if your symptoms don't get better after a few days.

Is it safe to drink alcohol while breastfeeding?

Anything that you put into your body while you are pregnant or breastfeeding can have an effect on your baby. This includes alcohol.

However, research shows that occasional drinking, such as one or two units once or twice a week, is not harmful to your baby while you are breastfeeding. Drinking any more than this can cause problems, such as affecting the mother's 'let down' reflex (release of milk to the nipple area). One unit is roughly equivalent to half a pint of regular beer, a 25ml (pub) measure of spirit, or a small (125ml) glass of wine.

Alcohol clears from the mother's blood at a rate of about one unit every two hours. If you do decide to have a drink, it's a good idea to wait for a couple of hours before breastfeeding. It can be difficult to predict when your baby may want to feed, so some mothers plan ahead and express milk beforehand for special occasions where they may want to have a drink.

Moderation is key - drinking anymore than a couple of units at a time can affect the baby's development and reduce your milk supply. Small amounts of alcohol pass into breast milk, making it smell different, which may affect your baby's feeding, sleeping or digestion. To be on the safe side, some women choose to avoid alcohol altogether while they are breastfeeding.

Is it safe to have the flu jab whilst pregnant or breastfeeding?

The Department of Health advises that it is safe for pregnant women to have the flu jab, but that they should have the thiomersal-free vaccine (mercury-free) wherever possible. It is considered that the benefits of having the vaccination outweigh the risks of exposure to thiomersal.

Some pregnant women have medical conditions (such as chronic disease of the heart, lungs, liver or kidneys) which suppress their immune systems, making a bout of flu more severe. Again, in these cases the benefits of having the jab are greater than any possible risks, and vaccination should take place before the flu season begins, regardless of the stage of pregnancy.

Clinical studies have shown no adverse effects from the flu jab on pregnant women (or their babies) or those who are breastfeeding, as the virus in the vaccine is inactivated.

Is it safe to use fake tan on my breasts while breastfeeding?

Fake tanning lotions and sprays are a popular and safer alternative to spending time in the sun to get a tan.

The active ingredient in fake tan is Dihydroxyacetone (DHA) - it reacts with the outermost layer of skin to produce the brown colour. The outer skin cells are already dead, and are shed as the skin renews itself, which means fake tan has to be reapplied. The DHA doesn't go beyond the outer layer of skin and isn't absorbed into the body.

Therefore, using fake tan on your breasts while breastfeeding, should not cause any harm to your baby. However, you may wish to avoid applying tanning lotion to the nipple area where the baby feeds from.

You should always test tanning lotion on a small area of skin before using it, in case you have an allergic reaction. Changes in hormone levels mean your skin may be more sensitive than normal when you are breastfeeding.